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Organization
SOUTHERN PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES, LLC
Active
Organization
SOUTHERN PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KNICOLE ANN LEE (OWNER)
(912) 278-0410
Entity
Organization
Contact information
Practice address
224 PEACHTREE ST, BAXLEY, GA 31513-8079
(912) 278-0410
Mailing address
64 MONY ST, BAXLEY, GA 31513-7135
(912) 278-0410
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/17/2022
Last updated
08/17/2022
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